Bottom Line:
These responders demonstrated a decrease in the pelvic pain scale and urgency scale from 7.7 ± 1.0 and, 6.6 ± 0.9 to 3.4 ± 2.5 and 4.3 ± 2.4 after 12 months, respectively (p < 0.05).Two responders, who received an additional course of HBO 12 and 13 months after initial treatment, respectively, did not suffer impairment for more than two years.It was well tolerated and provided maintained amelioration of pain, urgency and urinary frequency for at least 12 months.

Affiliation: Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan. tomoaki826@kde.biglobe.ne.jp

ABSTRACT

Background: There is no confirmed strategy for treating painful bladder syndrome/interstitial cystitis (PBS/IC) with unclear etiology. Therefore, a pilot study was carried out to evaluate the efficacy and safety of hyperbaric oxygen (HBO) therapy in treatment-resistant PBS/IC patients.

Methods: HBO treatment (2.0 ATA for 60 minutes/day × 5 days/week for 2 or 4 weeks) was performed on 11 patients with severe symptoms that had not been improved by previous therapy regimens between December 2004 and July 2009.

Results: Seven of the 11 patients demonstrated persistent improvement in symptoms during the 12 months after HBO treatment. These responders demonstrated a decrease in the pelvic pain scale and urgency scale from 7.7 ± 1.0 and, 6.6 ± 0.9 to 3.4 ± 2.5 and 4.3 ± 2.4 after 12 months, respectively (p < 0.05). The total score of the interstitial cystitis symptom index and 24-hour urinary frequency demonstrated a significant sustained decrease from the baseline. Two responders, who received an additional course of HBO 12 and 13 months after initial treatment, respectively, did not suffer impairment for more than two years. There was one case of transient eustachian tube dysfunction and three cases of reversible exudative otitis media as a consequence of HBO treatment.

Conclusions: HBO is a potent treatment for PBS/IC patients resistant to conventional therapy. It was well tolerated and provided maintained amelioration of pain, urgency and urinary frequency for at least 12 months.

Figure 1: Changes in evaluated parameters (the total score of ICSI, the scale of pain and urgency on VAS, 24-hour voiding frequency and maximum bladder volume) from the baseline in seven responders after three, six, nine, and 12 months follow-up after HBO treatment. The bottom and top of the box are the lower and upper quartiles, respectively, and the ends of whiskers represent the minima and maxima of the samples.

Mentions:
The patients comprised 10 females and one male; the mean age was 60.0 years (range 28-79 years). The PBS/IC diseases in these 11 patients included eight cases of ulcerative type and three of non-ulcerative type, according to intravesical endoscopic findings (Table 1). Patients were followed up for a median period of 14 months (range 3-50 months) after HBO therapy. Seven of the 11 patients were classed as responders. Four patients, who demonstrated no remission or short-term improvement, were considered non-responders. Three of four non-responders had non-ulcerative endoscopic findings (Table 1). At the end of the HBO sessions, seven responders demonstrated a significant improvement in symptoms compared to the pre-treatment baseline (p < 0.05), and had sustained amelioration with mild impairment during the following 12 months (Figure 1). After 12 months, the scales concerning pelvic pain and urgency were still decreased from 7.7 ± 1.0 and 6.6 ± 0.9 to 3.4 ± 2.5 and 4.3 ± 2.4, respectively (p < 0.05). The total score of ICSI decreased from 26.7 ± 7.0 to 18.7 ± 7.4 (p < 0.05), and the 24-hour voiding frequency decreased from 22.4 ± 4.0 to 14.6 ± 2.0 (p < 0.05). Two patients (cases one and two) in the responder group, who had received 20 sessions at the time of the initial report, underwent 10 secondary sessions of HBO treatment 13 and 14 months after initial HBO therapy, respectively. The symptoms in these patients remained stable for more than two years. In addition, cystoscopic examination demonstrated marked granulation of the ulcerative lesion (Figure 2) at the end of HBO treatment in all responders. With regards to adverse events, there was transient eustachian tube dysfunction in one case and reversible exudative otitis media in three cases. However, no patients discontinued HBO treatment because of these side effects.

Figure 1: Changes in evaluated parameters (the total score of ICSI, the scale of pain and urgency on VAS, 24-hour voiding frequency and maximum bladder volume) from the baseline in seven responders after three, six, nine, and 12 months follow-up after HBO treatment. The bottom and top of the box are the lower and upper quartiles, respectively, and the ends of whiskers represent the minima and maxima of the samples.

Mentions:
The patients comprised 10 females and one male; the mean age was 60.0 years (range 28-79 years). The PBS/IC diseases in these 11 patients included eight cases of ulcerative type and three of non-ulcerative type, according to intravesical endoscopic findings (Table 1). Patients were followed up for a median period of 14 months (range 3-50 months) after HBO therapy. Seven of the 11 patients were classed as responders. Four patients, who demonstrated no remission or short-term improvement, were considered non-responders. Three of four non-responders had non-ulcerative endoscopic findings (Table 1). At the end of the HBO sessions, seven responders demonstrated a significant improvement in symptoms compared to the pre-treatment baseline (p < 0.05), and had sustained amelioration with mild impairment during the following 12 months (Figure 1). After 12 months, the scales concerning pelvic pain and urgency were still decreased from 7.7 ± 1.0 and 6.6 ± 0.9 to 3.4 ± 2.5 and 4.3 ± 2.4, respectively (p < 0.05). The total score of ICSI decreased from 26.7 ± 7.0 to 18.7 ± 7.4 (p < 0.05), and the 24-hour voiding frequency decreased from 22.4 ± 4.0 to 14.6 ± 2.0 (p < 0.05). Two patients (cases one and two) in the responder group, who had received 20 sessions at the time of the initial report, underwent 10 secondary sessions of HBO treatment 13 and 14 months after initial HBO therapy, respectively. The symptoms in these patients remained stable for more than two years. In addition, cystoscopic examination demonstrated marked granulation of the ulcerative lesion (Figure 2) at the end of HBO treatment in all responders. With regards to adverse events, there was transient eustachian tube dysfunction in one case and reversible exudative otitis media in three cases. However, no patients discontinued HBO treatment because of these side effects.

Bottom Line:
These responders demonstrated a decrease in the pelvic pain scale and urgency scale from 7.7 ± 1.0 and, 6.6 ± 0.9 to 3.4 ± 2.5 and 4.3 ± 2.4 after 12 months, respectively (p < 0.05).Two responders, who received an additional course of HBO 12 and 13 months after initial treatment, respectively, did not suffer impairment for more than two years.It was well tolerated and provided maintained amelioration of pain, urgency and urinary frequency for at least 12 months.

Affiliation:
Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan. tomoaki826@kde.biglobe.ne.jp

ABSTRACT

Background: There is no confirmed strategy for treating painful bladder syndrome/interstitial cystitis (PBS/IC) with unclear etiology. Therefore, a pilot study was carried out to evaluate the efficacy and safety of hyperbaric oxygen (HBO) therapy in treatment-resistant PBS/IC patients.

Methods: HBO treatment (2.0 ATA for 60 minutes/day × 5 days/week for 2 or 4 weeks) was performed on 11 patients with severe symptoms that had not been improved by previous therapy regimens between December 2004 and July 2009.

Results: Seven of the 11 patients demonstrated persistent improvement in symptoms during the 12 months after HBO treatment. These responders demonstrated a decrease in the pelvic pain scale and urgency scale from 7.7 ± 1.0 and, 6.6 ± 0.9 to 3.4 ± 2.5 and 4.3 ± 2.4 after 12 months, respectively (p < 0.05). The total score of the interstitial cystitis symptom index and 24-hour urinary frequency demonstrated a significant sustained decrease from the baseline. Two responders, who received an additional course of HBO 12 and 13 months after initial treatment, respectively, did not suffer impairment for more than two years. There was one case of transient eustachian tube dysfunction and three cases of reversible exudative otitis media as a consequence of HBO treatment.

Conclusions: HBO is a potent treatment for PBS/IC patients resistant to conventional therapy. It was well tolerated and provided maintained amelioration of pain, urgency and urinary frequency for at least 12 months.